Still catching up with EMR

All the ultrasound data for December is now entered. I added up the number of births that I did this year and it was 190 down from my high of 334 (2004) and up from my low of 138 (2001). Now all I have to do is get all the OB visits entered into the EMR prior to 1/2/08 when the office re-opens. My partner is on call these days, but I delivered almost everyone, so her days will probably be easy. I hope so. We are facing a big new year. I will be off for quite a while (12 weeks) due to knee replacement and she will be doing it all. I hope there is a practice for me to come back to when I'm healed from my knee. I keep seeing many requests for (partner's name) for care and delivery in the charts. If I'm not there working perhaps no one will want me to do their delivery.

EMR "electronic medical records"

Ah yes, the practice I am associated with has made the big transition to EMR's. Most of the time having the chart absolutely available all the time is wonderful. I am never searching for a paper chart. I am never looking for stuff that hasn't been filed properly. I am never looking for paper that hasn't been filed yet. HOWEVER, the 1 tenth of a percent when there is a server failure, I am left with nothing. That is not even a hint of what has gone on in the past. I don't know what labs have been drawn (of course they come electronically). I don't know the estimated date of delivery. I don't know any of the psycho-social history. I don't know anything that I can't remember on my own. Now you may be getting a hint of the fact that there has been a server failure in my practice and you would be so right. When this happens you scribble notes to yourself on little pieces of paper and put those pieces of paper into folders to be addressed later (when the server has been repaired). This doesn't sound bad, except that this went on for most of December, off and on so now that I have a few days where I am not at the birthing barn, I'm tied to the computer trying to get my nose above the surface so that I will be able to function in the new year. YUCK. I do love electronic records when they work well, but when they don't work it makes life absolutely awful.

The Operating Room Conundrum

The hospital where I deliver has had a recent upgrade and we now have a dedicated operating room in our labor and delivery suite, directly across from our newborn nursery. This should be wonderful on many levels. We now meet the state requirements (we had a waiver of this requirement for 10 years); we now should not be doing surgery in an area where sick and infected people are being operated on; we now should not have to travel from the first floor front to the second floor back with a patient in heaven knows what awkward position in order to deliver her infant by cesarean section; we now have nursery and infant care/resuscitation equipment readily available without a trek through the halls and the potential of being stuck in an elevator with a sick new born (yes, this really happened)! Except for a pissing contest between two departments this would be true. OB did get a beautiful operating room in the recent remodel. It is directly across the hall from the newborn nursery. The issue is that we are not allowed to use it! There was inadequate training of the OB nurses for their roll in the OR. There was reluctance from the OR staff in opening an operating room out of the main OR area. There were kinks to iron out pertaining to personnel and patients all of which take time, communication, and problem solving. We used the new OR for about 6 months and then it was arbitrarily closed down because of politics. I am frustrated and angry because no one is being well served in this little fit of temper. The OB patients are now being processed in day surgery and operated on the in main OR in a room that is too small, and that is inadequately set up without appropriate oxygen connections. The patients are moved through the main hospital halls from the operating room to the OB unit. The babies are transported through the main hospital halls from the operating room to the OB unit. This transportation is not only cumbersome, it is unnecessary. There is a functional operating room right in the Labor and Delivery Unit. What we need is responsibility, accountability, and communication in order to safely and successfully use the OR located in labor and delivery for operative delivery of obstetric patients.